POS1093 EFFECT OF DISEASE MODIFYING ANTI-RHEUMATIC DRUGS ON DEPRESSION IN PATIENTS WITH PSORIATIC ARTHRITIS IN A LONGITUDINAL COHORT
Authors: A. J. Mathew, M. Sutton, D. Pereira, D. D. Gladman, V. Chandran
Journal: Annals of the Rheumatic Diseases (2022)

Background Depression, and its improvement with disease modifying anti-rheumatic drugs (DMARDs) is understudied in psoriatic arthritis (PsA). Objectives To determine the effectiveness of DMARDs on depression in PsA patients. Methods Patients enrolled from January 2000 to May 2020 in a large PsA cohort were included. Depression was defined as medical outcomes study short form-36 (SF-36) mental component summary score (MCS) ≤ 40 or mental health (MH) subscale score ≤ 56. Primary outcome was resolution of depression within 1 year of DMARDs, defined by two definitions: 1) MCS &gt; 40 and/or MH subscale score of &gt; 56; 2) Increase in MCS by 2.5 and MH subscale score by 5, the minimal clinically important difference (MCID). Baseline medications [non-steroidal anti-inflammatory drugs (NSAIDs) and/or conventional or targeted (c/t) DMARDs] were recorded for all patients and stratified into 3 mutually exclusive ordinal categories: I-No treatment/NSAIDs; II-cDMARDs±NSAIDs without tDMARDs; III-tDMARDs±cDMARDs/NSAIDs. Univariable and multivariable logistic regression models were created to determine the association between medications and resolution of depression, after controlling for age, sex, disease duration and baseline MCS/MH subscale score. Results Based on the MCS and MH subscale score definitions, 608 (48%) and 655 (52%) of the 1270 patients, respectively were depressed at baseline. 374 (50.8% males) and 399 (52.4% males) patients were followed up in the groups defined by MCS and MH subscales, respectively for 1 year. Patients in both groups had comparable body mass indices, baseline psoriasis area and severity index and active joint count. Mean MCS and MH subscale scores (standard deviation) were 33.2 (5.2) and 46.0 (10.2). A mean of 11.9 and 11.7 months was noted for resolution of depression in the MCS based analysis and MH subscale-based analysis groups, respectively. More patients achieved resolution of depression based on definition 2 (MCS, 64.7%; MH, 62.2%) as compared to definition 1 (MCS, 54.5%; MH, 53.9). The proportion of patients on each category of medications in both models is shown in the Figure 1. Table 1 depicts the univariate and multivariable regression results by both the definitions of primary outcome in the MH subscales model. The global p-value for medication categories showed a trend towards significance in both models using definition 2. There was a trend towards higher likelihood of response when comparing patients in treatment category III vs category I. A significant response was noted when comparing patients in category III with category II as reference (OR 1.71; 95% CI 1.05-2.76; p 0.03). No significant effect of treatment category on depression was noted using definition 1. Table 1. Association between treatment and resolution of depression in the MH Subscale model (n = 399 ) Variable Resolution by MCID Resolution by MH subscale reduction Univariable model Multivariable model Univariate model Multivariate model OR (95% CI ) p value OR (95% CI ) p value OR (95% CI ) p value OR (95% CI ) p value Male vs. Female 0.81 (0.54–1.22) 0.31 0.83 (0.5–1.26) 0.39 1.02 (0.68–1.51) 0.94 0.94 (0.63 –1.42) 0.79 Baseline age 1.01 (1.00 –1.03) 0.09 1.01 (1.00 –1.03) 0.16 1.02 (1.00–1.03) 0.05 1.01 (0.99 –1.03) 0.30 Baseline PsA duration 1.02 (1.00 –1.04) 0.12 1.01 (0.99 –1.03) 0.37 1.02 (1.00– 1.04) 0.07 1.01 (0.99 –1.03) 0.22 Baseline MH subscale score 0.98 (0.96 –1.00) 0.03 0.98 (0.95 –1.00) 0.02 1.04 (1.02– 1.06) &lt;0.0001 1.04 (1.02 –1.06) &lt;0.0001 Medication category 0.07* 0.09* 0.20* 0.20* I Reference II 0.81 (0.48 –1.36) 0.42 0.83 (0.48 –1.41) 0.48 1.09 (0.65– 1.82) 0.75 1.12 (0.66 –1.91) 0.67 III 1.40 (0.84 –2.36) 0.20 1.41 (0.83 –2.38) 0.20 1.51 (0.92– 2.49) 0.10 1.55 (0.92 –2.59) 0.10 *global p value Figure 1. Patients in each drug category. Conclusion In an observational setting, resolution of depression occurs in majority of patients with PsA within 1 year. Patients on t-DMARDs may experience better improvement in depression compared to other treatments. Future effectiveness studies warrant better definitions of depression and treatment response. Acknowledgements AJM was supported by the National Psoriasis Foundation Fellowship grant. Disclosure of Interests Ashish Jacob Mathew Speakers bureau: Novartis, IPCA Laboratories, Grant/research support from: Novartis, IPCA Laboratories, Mitchell Sutton: None declared, Daniel Pereira: None declared, Dafna D Gladman Consultant of: AstraZeneca, Grant/research support from: AbbVie, Vinod Chandran Consultant of: AbbVie, Amgen, BMS, Eli Lilly, Janssen, Novartis, Pfizer and UCB, Grant/research support from: AbbVie, Amgen and Eli-Lilly